Review article
PROPHYLAXIS OF NEONATAL DISEASE CAUSED BY GROUP B BETA HAEMOLYTIC STREPTOCOCCUS
Milan Stanojević
; Klinika za ginekologiju i porodništvo Medicinskog fakulteta u Zagrebu, Opća bolnica »Sv. Duh«, Zagreb, Sv. Duh 64, 10 000 Zagreb
Anita Pavičić-Bošnjak
; Klinika za ginekologiju i porodništvo Medicinskog fakulteta u Zagrebu, Opća bolnica »Sv. Duh«, Zagreb, Sv. Duh 64, 10 000 Zagreb
Ratko Matijević
; Klinika za ginekologiju i porodništvo Medicinskog fakulteta u Zagrebu, Opća bolnica »Sv. Duh«, Zagreb, Sv. Duh 64, 10 000 Zagreb
Berivoj Mišković
; Klinika za ginekologiju i porodništvo Medicinskog fakulteta u Zagrebu, Opća bolnica »Sv. Duh«, Zagreb, Sv. Duh 64, 10 000 Zagreb
Dubravko Habek
; Klinika za ginekologiju i porodništvo Medicinskog fakulteta u Zagrebu, Opća bolnica »Sv. Duh«, Zagreb, Sv. Duh 64, 10 000 Zagreb
Abstract
Group B streptococcus (GBS) could cause severe fetal, neonatal and infant infection. Fetal aspiration of infected amniotic fluid can lead to stillbirth, conatal pneumonia, or sepsis. Infants can also become infected with GBS during passage through the birth canal, although the majority of infants who are exposed to the organism through this route become colonized on skin or mucous membranes but remain asymptomatic, while some of them develop early onset GBS neonatal disease during the first 7 days of life, while late GBS disease can develop after 7 days till three months of life. It is estimated that prevalence rate of GBS disease in neonatal period before introduction of intrapartal prophylaxis was 2 to 15 per 1000 live-births of which 80% were early and 20% late onset GBS disease. Approximately 6,5% to 36% of pregnant women are colonizated with GBS, most of them asymptomatic. It is estimated that bacteriuria caused by GBS complicate 2%–4% of pregnancies. Due to intrapartal prophylaxis prevalence rate of GBS decreased to 0,5 per 1000 live-births, while case fatality rate declined from 50% before era of intrapartal prophylaxis to 4% after introduction of intrapartal prophylaxis in United States of America (USA). In Croatia after introduction of intrapartal prophylaxis prevalence of early neonatal GBS disease declined from 15 to 10 per 1000 live-births. Recommendations for intrapartum prophylaxis to prevent perinatal GBS disease in USA were issued in 1996 by the American College of Obstetricians and Gynecologists and Center for Disease Control, and in 1997 by the American Academy of Pediatrics, which were updated in 2002. The guidelines from 1996 recommended the use of one of two prevention methods, a risk-based approach or a culture-based screening approach. According to updated recommendations, culture-based screening approach is only appropriate, because it is over 50% more effective. Recommendations for the prevention of GBS neonatal disease do not exist in Croatia. According to the American recommendations, if there was bacteriuria in pregnancy, or vaginal and rectal cultures between 35 and 37 gestational weeks were GBS positive or infant from previous pregnancy suffered severe early onset GBS disease, or if screening results were not known in pregnant women with <37 weeks of gestation with one of the following risk factors: rupture of membranes 18 hours, intrapartum temperature 38,0°C, in that case intrapartal prophylaxis is indicated. Penicillin G remains the agent of choice for intrapartum antibiotic prophylaxis and treatment of GBS disease (Ampicillin is an acceptable alternative). Among penicillin-allergic women not at high risk for anaphylaxis, cefazolin is the agent of choice for intrapartum chemoprophylaxis because of its narrow spectrum of activity and ability to achieve high intraamniotic concentrations,. For penicillin-allergic women at high risk for anaphylaxis, testing of GBS isolates from prenatal screening for susceptibility to clindamycin and erythromycin is recommended. Vancomycin should be reserved for penicillin-allergic women at high risk for beta-lactam anaphylaxis when clindamycin or erythromycin are not options because of in vitro resistance or unknown susceptibility of a prenatal isolate. Intravenous administration is the only route of administration recommended for intra-partum chemoprophylaxis to prevent perinatal GBS disease.
Keywords
group B streptococcus; early onset neonatal disease; intrapartum prophylaxis; recommendations
Hrčak ID:
65969
URI
Publication date:
1.12.2009.
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